| NPI | 1225390719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MS 24316) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL34725) |
| 207N00000X Dermatology (Licence: LA PGY..202111) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2016-07-14 |